American family physician
-
Endometriosis is an inflammatory condition caused by the presence of endometrial tissue in extra-uterine locations and can involve bowel, bladder, and all peritoneal structures. It is one of the most common gynecologic disorders, affecting up to 10% of people of reproductive age. Presentation of endometriosis can vary widely, from infertility in asymptomatic people to debilitating pelvic pain, dysmenorrhea, and period-related gastrointestinal or urinary symptoms. ⋯ All of these treatments are effective but may cause additional adverse effects. Referral to gynecology for surgical management is indicated if empiric therapy is ineffective, immediate diagnosis and treatment are necessary, or patients desire pregnancy. Alternative treatments have limited benefit in alleviating pain symptoms but may warrant further investigation.
-
The spiritual assessment offers the opportunity to enhance the patient-physician relationship and incorporate patient views that may have a significant impact on clinical decision-making. Multiple studies have demonstrated that patients' expectations of spiritual discussions in the health care setting are not being met. Perceived barriers reported by physicians include lack of time, training, and experience. ⋯ A spiritual assessment is recommended when a patient is admitted to the hospital, has a significant clinical decline while in the hospital, is receiving psychosocial services for the treatment of substance use disorder, or when addressing palliative care. Tools for spiritual assessment include the Open Invite mnemonic, which initiates the topic and relies on a conversational approach, and the HOPE questions, which offer a structured approach to determine the relevance of spirituality to the patient's overall health and assist with the development of an individualized care plan. Although physicians should respect the right of patients who do not want to discuss this topic, multiple studies demonstrate significant relationships between spiritual interventions and improved mental and physical health outcomes.
-
About 60% of adults in the United States have one or more diet-related chronic diagnoses, including cancer, cardiovascular and cerebrovascular diseases, diabetes mellitus, and obesity. It is imperative to address nutrition health in the clinical setting to decrease diet-related morbidity and mortality. Family physicians can use validated nutrition questionnaires, nutrition-tracking tools, and smartphone applications to obtain a nutrition history, implement brief intervention plans, and identify patients who warrant referral for interdisciplinary nutrition care. ⋯ Department of Agriculture 2020-2025 Dietary Guidelines for Americans when assessing patient nutrient intake quality and pattern; however, it is also essential to assess nutrition health within the context of an individual patient. It is important to maintain a basic understanding of popular diet patterns, although diet pattern adherence is a better predictor of successful weight loss than diet type. Using various counseling and goal-setting techniques, physicians can partner with patients to identify and develop a realistic goal for nutrition intervention.
-
Schizophrenia is the most common psychotic mental disorder, and those affected have two to four times higher mortality than the general population. Genetic and environmental factors increase the risk of developing schizophrenia, and substance use disorder (particularly cannabis) may have the strongest link. Schizophrenia typically develops in young adulthood and is characterized by the presence of positive and negative symptoms. ⋯ Treatment-resistant schizophrenia should be treated with clozapine. Adjunctive treatments include electroconvulsive therapy, antidepressants, and cognitive behavior therapy for psychosis. Family and social support are keys to improved outcomes.